Nearly 5 million Americans are infected with hepatitis C, and more than 80% of these individuals are baby boomers. Alarmingly, 75% of people with hepatitis C aren’t aware they are infected. In August 2012, the CDC issued new guidelines recommending that all baby boomers (those born between 1945 and 1965) have a onetime test for hepatitis C. This could detect another 800,000 of those infected and potentially save 120,000 lives. Characterizing Hepatitis C Hepatitis C remains the only viral infection that can be cured, and this move toward broader testing comes at an important time as therapy continues to improve. Cure rates with protease inhibitors recently approved by the FDA range between 68% and 79%. For many patients, these therapies will cut treatment time in half. With more than 50 drugs in development, the cure rate is likely to improve to greater than 90% over the next 5 to 10 years, and therapy will be easier to tolerate and take less time to become effective. Testing Baby Boomers for Hepatitis C Testing for hepatitis C has been shown in studies to be cost-effective, especially as the epidemic costs the U.S. an estimated $30 billion per year. That number is projected to rise to $80 billion per year by 2025. Curing the majority of those affected will dramatically reduce those costs. Physicians should recognize that routine physical exams may not detect hepatitis C. Up to 40% of infected people will have normal liver blood tests, so a specific antibody test must be conducted. In addition to talking to baby boomers about hepatitis C testing, physicians should also discuss testing with...

There is much hand-wringing about the shortage of primary care physicians. But primary care is not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery: Demand-Side Facts The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million. As Baby Boomers age, the increase in the population of the elderly will result in more need for general surgeons. There are already many rural areas that are underserved by general surgeons. Supply-Side Facts The number of general surgeons needed to adequately serve the population is estimated to be at least 7 per 100,000 people. Currently, there are about 18,000 active general surgeons in the US, or 5.8 per 100,000 people. The ratio of general surgeons per 100,000 population has dropped by 26% in the last 25 years. Medical schools are expanding class sizes and a few new schools are opening, but it will take several years for the impact of these changes to be felt. Residency programs produce about 1,050 new general surgeons per year — a rate that has been level for almost 20 years. The prospects for increasing the number of surgeons being trained are limited. A recent paper in the journal Academic Medicine showed that even if all of the current 246 general surgery training programs expanded as much as they possibly could, the best-case scenario would be an increase to about 1,500 new surgeons per year. The cost of funding this increase is estimated at...

The population of baby boomers and geriatric adults—the “boomeratric”™ generation—is continuing to increase in the United States. Roughly 40 million Americans are 65 or older, representing 12.9% of the total population (or one in every eight people). There will also be about 72.1 million older Americans by 2030, a growth of about 19%. As the boomeratric™ generation continues to age, they become increasingly prone to falls and fractures because of their frailty. Timely evaluation and treatment after bone fractures lead to better outcomes. At Geisinger Health System and other medical centers throughout the country, hospitals are starting to establish geriatric fracture care programs. These initiatives utilize evidence-based medicine to address the aging population and a complete team approach to provide quality comprehensive care. Using the latest research, a series of protocols is followed to deliver best practice medicine throughout the entire care process. Geriatric fracture care programs connect patients with the resources they need to expedite recovery and help them take steps to stay healthy and prevent future injury. Coordinated, Evidence-Based Care Members of the geriatric fracture care team include nurse coordinators, emergency physicians, physical and occupational therapies, orthopedic surgeons, hospitalists, pharmacists, care managers, physician assistants, rheumatologists, dietitians, blood conservation services, and nurses. Nurse coordinators play an integral role in streamlining processes—speaking with patients regularly, keeping track of their progress, and guiding them throughout the care process. It’s their job to facilitate family involvement in the care of patients to improve outcomes. They also help maintain centralized electronic medical records and order sets. These enable all members of the geriatric fracture care team to stay up to date and...